Attracting physicians to Kona will require a combination of raising reimbursement rates from medical insurance providers and lowering rates for medical malpractice insurance, physicians and a state official said Wednesday.

Four doctors, including Kona Community Hospital's medical and emergency room directors and state Rep. Josh Green, D-North Kona, Keauhou, Kailua-Kona, and state insurance commissioner J.P. Schmidt spoke as panel members at a Hawaii Medical Association forum addressing patient access to care. About 30 members of the public attended the forum at King Kamehameha's Kona Beach Hotel, but only a handful addressed questions to the panel.

Key is removing a malpractice suit target from physicians' backs, Schmidt and Barry Blum, the hospital medical director, said.

"Something needs to be done so we have a more rational

legal system," Schmidt said, adding that he isn't advocating capping economic damages in malpractice awards. "With noneconomic damages, they have no standing to calculate them by. That's a bad legal system. You don't have equal cases being treated equally."

Green also told forum attendees that he started a process to require an audit of Hawaii Medical Service Association's financial records. HMSA is the largest medical insurance provider in the state, and, physicians, legislators and others in the state contend, does not reimburse physicians adequately for services provided to patients.

"I fully applaud your effort to audit HMSA," Joel Gimpel told Green.

But Gimpel said he questioned how effective some of the medical malpractice reforms would be in lowering premiums physicians pay.

Blum had an answer.

"It lowers the size of the target," he said.

Richard McDowell, Kona Community Hospital emergency room director, said he sees medical malpractice reform as just one part of what West Hawaii needs to attract and retain physicians. Other needs are competitive reimbursement rates, modern technology and modern facilities. Some of the new technology is there, but facilities need to be improved, he said.